title: Tumefactive MS lesions under fingolimod: a case report and literature review.
abstract: OBJECTIVE
  To report about a possible association between fingolimod treatment and tumefactive demyelinating lesions (TDL) as seen in a patient developing repeated TDL on continued fingolimod therapy.
  
  
  METHODS
  We performed serial clinical and radiologic assessments and immunophenotyping of blood and CSF immune cells. We also present a literature review about recent similar cases.
  
  
  RESULTS
  Clinical course and radiologic findings were consistent with diagnosis of TDL. Immune cell phenotyping showed pronounced shifts in the immune cell composition related to fingolimod treatment. In addition, we observed a subset of highly differentiated effector cells (CD45R0negCCR7neg) within the CD8+ T-cell population, which was about 2-fold enriched in the CSF compared to the peripheral blood.
  
  
  CONCLUSIONS
  Our observations add further evidence for the development of atypical demyelinating lesions in some patients receiving fingolimod. These might be related to a treatment-associated shift in the immunopathology of specifically susceptible individuals.
authors.affiliation: From the Department of Neurology (G.P., A.H., P.W., K.O., J.S., E.T., J.K.), Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; the Department of Neurology (J.S.), Klinikum rechts der Isar, Technische Universität München, Germany; and the Department of Neurology (F.F.), Medical University of Graz, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Pilz
authors.forename: Andrea
authors.initials: A
authors.lastname: Harrer
authors.forename: Peter
authors.initials: P
authors.lastname: Wipfler
authors.forename: Katrin
authors.initials: K
authors.lastname: Oppermann
authors.forename: Johann
authors.initials: J
authors.lastname: Sellner
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
authors.forename: Joerg
authors.initials: J
authors.lastname: Kraus
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D005260:Female; D000068876:Fingolimod Hydrochloride; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000276:immunology*; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D010951:Plasma Exchange; D011409:Propylene Glycols / Q000627:therapeutic use*; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D043025:Oligoclonal Bands; D011409:Propylene Glycols; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine